Purpose

Proposed decision:
 
Extend the Supported
Living Contract, for a maximum of up to three years from 15 June
2024 to 14 June 2027 and delegate authority to the Corporate
Director Adult Social Care and Health to take other relevant
actions, including but not limited to finalising the terms of and
entering into required contracts or other legal agreements, as
necessary to implement the decision.
 

Reason for the decision:
 
The
Care Act 2014 gave local authorities in England, the NHS and the Care Quality Commission clear legal
responsibilities for managing different elements of the adult
social care market that include considering need, provider
sustainability, value for money and integration.
 
Framing
Kent’s Future and Securing Kent’s Future and the Adult
Social Care Making a Difference Everyday Strategy Kent identify New
Models of Care and Support as a key priority by recognising the
importance of health and social care integration, building
effective strategic partnerships with our providers through
coproduction whilst being innovative in the way we look to redesign
services to improve quality and importantly respond to budget
constraints.
 
To help
achieve this, the council has procured external expertise to
undertake three distinct pieces of work that will help with the
redesign of a new service. This will help inform the commissioning
intentions for adult social care services and provide commissioners
with the required information to design new specifications and a
robust commissioning and procurement process.
 
The
commissioning exercise will include extensive engagement with
people who use care and support services to develop a new
specification which ensures high quality and cost-effective
services in the future.
 
This is
a demand driven service and due to increases in complexity,
increased demand and fees in excess of
that funded for inflation, spend has grown year on year. It is
recognised that during the contract extension period mitigations
will be put in place to help halt the increased spend to the
service through the development of a robust savings action plan.
This will require a collaborative approach across Kent County
Council (KCC) and NHS Kent and Medway Integrated Care Board (ICB)
colleagues and proactively engaging with providers to determine
fair costs for both legacy and new placements.
 
The
council will need to consider looking to develop alternative care
and support offers which support people to remain in their own home
for longer. These include an enhanced technology offer, integrated
reablement service, homecare offer, increasing direct payments and
support that can be purchased such as personal assistants and niche
services delivered by the voluntary sector and micro
providers.
 
Commissioners will develop new models, supported by the cost of
care exercise completed by the external consultants, which will
ensure best value for future services. The extension will allow
this activity to be completed.
Supported Living is intended to allow people with disabilities
and other long-term conditions to remain independent and have their
own home. The features of the contract include suitable housing,
paid for by the resident with support to help with everyday life
activities or in the event of physical or mental health challenges.
The contracting arrangements offer access to anyone over the age of
18 years old, as this is the legal age that a person can sign a
tenancy agreement.
 
The
contract is a closed framework with 94 providers contracted to
provide support to adults across Kent through approximately 700
properties.
 
When
the contract went live (in 2019) there were 500 properties on the
framework. The Supported Accommodation Team in Commissioning have
added approximately 250 properties to the framework
providers’ portfolios and ensuring these are of a good
standard by checking that all new properties meet the minimum
design specification (developed in 2017 and in line with housing
legislation), introduced at the point of tender, as well as due
diligence checks to ensure safety.
 
The
current contract end date is 14 June 2024 and there is an optional
3-year extension built into the contract, which could take the
contract through to 14 June 2027.
 
An
extension to the current contract is required to allow the external
consultants to complete the assessment and for the new service to
be procured. However, it is anticipated that the exercise carried
out by external experts will not be finalised until March 2024.
This will enable a full procurement process to commence once the
extensions to the contract has been
implemented.
 
The
proposed extension will be put in place for a maximum of up to
three years. However, a robust reprocurement exercise is to be completed as
quickly as possible and break clauses will be written into the
contract extension to allow the council to terminate the contract
when appropriate and to fit in with the mobilisation of a new
contract.
 
Subject
to the outcome of the work currently being undertaken by
consultants, we expect to commence the procurement process in April
2024 with a view to implement from early in 2025.
 
The
proposed decision supports objective 2 of Securing Kent’s
Future to deliver savings from identified opportunity areas to set
a sustainable 2024/25 budget and MTFP and priority 4 of Framing
Kent’s Future – New Models of Care and
Support.
 
Options (other options considered but discarded):
The council can choose not to extend the current
contract. However, there are significant risks, as set out below,
to choosing this option and no benefits have been
identified.

 

Legal and Policy: The council commissions services
from the independent sector to meet the needs of individuals deemed
to be eligible in accordance with and following a Care Act
assessment. If the contract ends the Council will be pressured to
fully meet its statutory obligation under the Care Act with regards
to providing a high quality, safe service that is at an affordable
price.

 

Financial: A lack of robust fee setting mechanisms
and contractual leverage may result in a significant increase in
placement costs which will be challenging to control. Savings
targets set out by the council and to be met through greater
partnership working and negotiation will be difficult to achieve
through spot purchasing agreements and providers will be within
their right to give notice on individual placements that may be
hard to source at an affordable price.

 

Reputational: A shift to partnership working with
providers will be challenged as the expectation from providers is
that the contractual arrangements with the Council will be
maintained due to the mutual benefits to both parties. People using
this service expect a robust oversight of the service and the
perception will be that this is not the case if the service is not
part of a KCC Contract.

 

Resource Implications: If the contract ends there
will be a requirement for the review, renegotiation, and
repurchasing of all individual placements with new contract and
terms and conditions established. This will also require
significant system and process updates.
 

Financial Implications:
 
The
initial contract cost is set out below along with the current cost.
Various market pressures and increase in demand and complexity of
care has resulted in an increased spend on the service. Robust
actions are being put in place to limit this spend.

 

Contract

Initial
contract cost advertised (per annum)

2022/23
spend

Supported Living

£68,000,000

£138,000,000

 
Dedicated commissioning and finance resources will be
required to ensure a collaborative approach to
determine a robust fee model and pricing guide and the
identification of any financial risk.
 

Legal Implications:

 
Anextension is necessary to
enable the council to undertake a detailed Cost of Care review,
which is likely to be completed by 28 February 2024. As such, the
council will not be in a position to
undertake a reprocurement, based on the
outcome of the review, in time for a new service to be in place in
2024. Therefore, a change is not proposed at
this time for economic or technical reasons. Any procurement
of the service, prior to the completion of the Cost of Care review,
will cause significant inconvenience and substantial duplication of
cost. It is also unlikely that a procurement will attract market
interest, as providers may be reluctant to bid, prior to the
completion of the Cost of Care review.

 
An
extension is available to be utilised in the contract. The
extension was included in the Contract / PIN Notice advertising the
original procurement of this service and therefore the extension is
permissible and compliant under PCR 2015 regulations.

 
 
 

Decision

Decision:
As Cabinet Member for Adult Social Care and
Public Health, I agree to:
a) EXTEND the Supported Living
contract, for a maximum of up to three years from 15 June 2024 to
14 June 2027; and
b) DELEGATE authority to the Corporate
Director Adult Social Care and Health to take other relevant
actions, including but not limited to finalising the terms of and
entering into required contracts or other legal agreements, as
necessary to implement the decision.